Provider Demographics
NPI:1891298139
Name:DUFFIN, KENYATTA MONIECE (LVN)
Entity type:Individual
Prefix:MRS
First Name:KENYATTA
Middle Name:MONIECE
Last Name:DUFFIN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 PAMPAS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-5221
Mailing Address - Country:US
Mailing Address - Phone:662-616-0254
Mailing Address - Fax:
Practice Address - Street 1:3501 PAMPAS CREEK DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-5221
Practice Address - Country:US
Practice Address - Phone:662-616-0254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227967164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse